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Khattab MH, Sherry AD, Kim E, Anderson J, Luo G, Yu H, Englot DJ, Chambless LB, Cmelak AJ, Attia A. Body mass index and response to stereotactic radiosurgery in the treatment of refractory trigeminal neuralgia: A retrospective cohort study. JOURNAL OF RADIOSURGERY AND SBRT 2020; 6:253-261. [PMID: 32185084 PMCID: PMC7065898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 07/11/2019] [Indexed: 06/10/2023]
Abstract
Stereotactic radiosurgery (SRS) is used as a noninvasive treatment option for patients with trigeminal neuralgia (TN), but the effect of obesity on pain relief post SRS, if any, is unknown. The primary goal of our study was to evaluate the association between obesity and response to SRS in patients with TN. We conducted an IRB-approved retrospective review of patients treated with SRS for TN between 2010 and 2017. Barrow Neurologic Institute (BNI) Score was assigned pre-and post-SRS to quantify pain level. Thirty-two patients (65% female) between the ages of 24 and 96 were studied with a median follow-up time of 11 months. Patients with BMI >25 were significantly less likely to have improvement in their symptoms with SRS (p = 0.005). Elevated BMI may be associated with worsened response to SRS in the treatment of TN.
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Affiliation(s)
- Mohamed H Khattab
- Department of Radiation Oncology, Vanderbilt University Medical Center, 2220 Pierce Avenue, PRB-B1003, Nashville, TN 37232, USA
| | | | - Ellen Kim
- Department of Radiation Oncology, Vanderbilt University Medical Center, 2220 Pierce Avenue, PRB-B1003, Nashville, TN 37232, USA
| | - Joshua Anderson
- Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Guozhen Luo
- Department of Radiation Oncology, Vanderbilt University Medical Center, 2220 Pierce Avenue, PRB-B1003, Nashville, TN 37232, USA
| | - Hong Yu
- Department of Radiation Oncology, Vanderbilt University Medical Center, 2220 Pierce Avenue, PRB-B1003, Nashville, TN 37232, USA
- Vanderbilt University School of Medicine, Nashville, TN 37232, USA
- Department of Biomedical Engineering, School of Engineering, Vanderbilt University, Nashville, TN 37232, USA
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Dario J Englot
- Department of Biomedical Engineering, School of Engineering, Vanderbilt University, Nashville, TN 37232, USA
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Lola B Chambless
- Department of Radiation Oncology, Vanderbilt University Medical Center, 2220 Pierce Avenue, PRB-B1003, Nashville, TN 37232, USA
- Vanderbilt University School of Medicine, Nashville, TN 37232, USA
- Department of Biomedical Engineering, School of Engineering, Vanderbilt University, Nashville, TN 37232, USA
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Anthony J Cmelak
- Department of Radiation Oncology, Vanderbilt University Medical Center, 2220 Pierce Avenue, PRB-B1003, Nashville, TN 37232, USA
| | - Albert Attia
- Department of Radiation Oncology, Vanderbilt University Medical Center, 2220 Pierce Avenue, PRB-B1003, Nashville, TN 37232, USA
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Somaza S, Montilla EM, Mora MC. Gamma knife radiosurgery on the trigeminal ganglion for idiopathic trigeminal neuralgia: Results and review of the literature. Surg Neurol Int 2019; 10:89. [PMID: 31528427 PMCID: PMC6744789 DOI: 10.25259/sni-134-2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 02/21/2019] [Indexed: 11/04/2022] Open
Abstract
Background In the present study, we evaluate the results of gamma knife surgery (GKS) for the treatment of trigeminal neuralgia (TN) using the trigeminal ganglion (TG') and the adjacent fibers of trigeminal nerve as a target. Methods From February 2013 to July 2017, we treated 30 cases of TN with GKS. In this group, all patients had an idiopathic typical TN. The radiosurgical target was conformed through two isocenters, 8 and 4 mm at the cavum de Meckel. The maximum dose was 86 Gy using the isodose line of 50%. The median age of the patients was 58.5 (range 28-94) years old, and the median time from diagnosis to GKS was 94 months (range 13-480 months). The median follow-up was 28.5 (range 12-49) months. Clinical outcomes were analyzed. Univariate and multivariate analyses were performed to evaluate factors that correlated with a favorable, pain-free outcome. Results The mean time to relief of pain was 7 (range 1-40) days. The percentage of patients with significant pain relief was 93.3%. Relapse in pain was noted in four patients at 3, 16, 19, and 36 months. Nine patients were treated in acute status. Fourteen patients had intense pain between 1 and 7 days before the procedure. Among those with the recurrence of their symptoms, one patient had a microvascular decompression. Multivariate regression adjusted for age and sex suggests that, by 40 months, 70% of the patients treated with radiosurgery will remain pain free. At the last follow-up, GKS resulted in pain relief in 86.6% of patients. Our analysis suggests that, using this technique, we can expect that approximately 70% of patients with TN will have some degree of pain improvement at 3 years' post radiosurgery. Conclusions GKS on TG appears to be a reasonable treatment option with short latency period, minor collateral effects, and high percentage of pain control. The mechanism of action of radiosurgery could be related to the inactivation of the satellite glial cells in the TG.
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Affiliation(s)
- Salvador Somaza
- Departments of Neurosurgery, Centro Diagnostico Docente Las Mercedes, Hospital de Clinicas Caracas, Caracas, Venezuela
| | - Eglee M Montilla
- Departments of Radiation Oncology, Centro Diagnostico Docente Las Mercedes, Hospital de Clinicas Caracas, Caracas, Venezuela
| | - Maria C Mora
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, United States
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Singh R, Ansinelli H, Jenkins J, Davis J, Sharma S, Vargo JA. Stereotactic radiosurgery and fractionated stereotactic radiosurgery for vestibular schwannomas: A comparison of clinical outcomes from the RSSearch patient registry. JOURNAL OF RADIOSURGERY AND SBRT 2019; 6:19-26. [PMID: 30775071 PMCID: PMC6355446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 11/08/2018] [Indexed: 06/09/2023]
Abstract
PURPOSE To compare clinical outcomes following stereotactic radiosurgery (SRS) and fractionated stereotactic radiosurgery (fSRS) for vestibular schwannomas (VS). MATERIALS/METHODS We identified 64 VS patients from the RSSearch Patient Registry (12 treated with SRS and 52 patients treated with fSRS). Potential factors predictive of local control (LC) and toxicity were estimated using the Kaplan-Meier method, Cox proportional hazards model, and binary logistic regressions with propensity score weighting. RESULTS SRS (100%) and fSRS (94.2%) resulted in similar LC (p = 0.33). fSRS was associated with a higher likelihood of experiencing toxicities (42.3% vs. 8.3%; p = 0.054 on time-to-event analysis) that was maintained following a propensity-score weighted binary logistic regression (p = 0.037) and propensity-score weighted Cox regression (p = 0.039; hazard ratio (HR) = 8.85 (95% CI: 1.1 - 70.1)). CONCLUSION In a multi-institutional analysis, we note equivalent LC but higher toxicity with fSRS compared to SRS for VS.
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Affiliation(s)
- Raj Singh
- Virginia Commonwealth University, Department of Radiation Oncology, Richmond, VA 23298, USA
| | - Hayden Ansinelli
- Virginia Commonwealth University, Department of Radiation Oncology, Richmond, VA 23298, USA
| | - Jan Jenkins
- The Radiosurgery Society, Sunnyvale, CA 94402, USA
| | - Joanne Davis
- The Radiosurgery Society, Sunnyvale, CA 94402, USA
| | - Sanjeev Sharma
- St. Mary’s Medical Center, Department of Radiation Oncology, Huntington, WV 25701, USA
- Marshall University Joan C. Edwards School of Medicine, Department of Radiation Oncology, Huntington, WV 25701, USA
| | - John Austin Vargo
- West Virginia University School of Medicine, Department of Radiation Oncology, Morgantown, WV 26506, USA
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Lakshman VB, Aal M, Karumanchi PK, Jaleel A, Iyer AP. Trigeminal Neuralgia Secondary to Vertebrobasilar Dolichoectasia Treated with Cyberknife Stereotactic Radiosurgery. Asian J Neurosurg 2019; 14:978-980. [PMID: 31497145 PMCID: PMC6703046 DOI: 10.4103/ajns.ajns_53_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Trigeminal neuralgia caused by vertebrobasilar dolichoectasia is a rare condition. It is characterized by paroxysmal hemifacial pain which is lancinating in type mostly refractory to medical management. This is a report of trigeminal neuralgia secondary to vertebral dolicholectasia refractory to medical management treated with cyber knife stereotactic radiosurgery to the dose of 66 Gy in single fraction to the proximal nerve root. Pain relief was achieved immediately after the treatment and with a follow up period of 2 years, patient is pain free. Cyberknife assisted radiosurgery is relatively safe in delivering high ablative doses with precise conformality to small target regions like proximal nerve root entry of trigeminal nerve with no major toxicities and achieving early pain relief. It is an outpatient and non-invasive procedure. It can be used as a definite treatment modality for trigeminal neuralgia induced by vertebrobasilar dolichoectasia.
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Affiliation(s)
- Vijay Bhaskar Lakshman
- Department of Radiation Oncology, Health Care Global Enterprises Ltd., Bengaluru, Karnataka, India
| | - Mahalaxmi Aal
- Department of Radiation Oncology, Health Care Global Enterprises Ltd., Bengaluru, Karnataka, India
| | - Pradeep Kumar Karumanchi
- Department of Radiation Oncology, Health Care Global Enterprises Ltd., Bengaluru, Karnataka, India
| | - Ayesha Jaleel
- Department of Radiation Oncology, Health Care Global Enterprises Ltd., Bengaluru, Karnataka, India
| | - Aarthi Pashupathy Iyer
- Department of Radiation Oncology, Health Care Global Enterprises Ltd., Bengaluru, Karnataka, India
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Berti A, Ibars G, Wu X, Sabo A, Granville M, Suarez G, Schwade JG, Jacobson RE. Evaluation of CyberKnife Radiosurgery for Recurrent Trigeminal Neuralgia. Cureus 2018; 10:e2598. [PMID: 30013862 PMCID: PMC6039152 DOI: 10.7759/cureus.2598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 05/09/2018] [Indexed: 11/07/2022] Open
Abstract
Stereotactic radiosurgery (SRS) has evolved as an accepted treatment for medication resistant trigeminal neuralgia. Initial results are very good but follow-up over three to five years shows a gradual return of pain in up to 50% of treated patients, often requiring further treatment. The results with repeat SRS using the isocentric Gamma Knife (GK) (Elekta, Stockholm, Sweden), especially in patients having initially good results, are very similar to the outcomes after the initial treatment although there is an increased risk of residual facial numbness secondary to the additional radiation dose to the trigeminal nerve. However, after 2000, non-isocentric SRS systems began to be used for treating trigeminal neuralgia including the CyberKnife (CK) (Accuray, Sunnyvale, California) as well as various linear accelerator (LINAC) based systems. This report specifically examines a series of recurrent trigeminal cases treated by the same group of physicians with the CK system. Similar doses and locations on the trigeminal nerve and/or the root entry zone were used for both initial and repeat SRS treatment regardless of system used. Although there are numerous series reporting the use of GK for recurrent treatment for recurrent trigeminal neuralgia, there are no series reviewing the results and long-term effectiveness using CK for repeat SRS for recurrent trigeminal pain. We reviewed 23 cases that had initial treatment for trigeminal neuralgia either surgically or with SRS with either the GK or CK and then a later second procedure only with CK. The follow-up after the second CK SRS ranged from three to 13 years found that the results are very similar to the multiple reports in the literature describing second or third SRS treatments with the GK. Results of repeat radiosurgery treatment of recurrent trigeminal neuralgia appear to be independent of the system used and are primarily based on proper target and dose to the trigeminal nerve.
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Affiliation(s)
- Aldo Berti
- Department Neurosurgery, University of Miami Hospital, Miami, USA
| | - George Ibars
- Neurosurgery, South Miami Hospital, Cyberknife Center of Miami
| | - Xiaodong Wu
- Innovative Cancer Institute, Innovative Cancer Institute, Cyberknife Center of Miami
| | - Alex Sabo
- Neurology, Pain Management, Nova Southeast/larkin Community Hospital
| | | | | | - James G Schwade
- Cyberknife Center of Miami, University of Miami Miller School of Medicine
| | - Robert E Jacobson
- Miami Neurosurgical Center, University of Miami Hospital, Miami, USA
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Berti A, Granville M, Jacobson RE. Oral Squamous Cell Carcinoma Found Inline with the Fields of Repeat Stereotactic Radiosurgery for Recurrent Trigeminal Neuralgia. Cureus 2018; 10:e2054. [PMID: 29545977 PMCID: PMC5849356 DOI: 10.7759/cureus.2054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 01/12/2018] [Indexed: 11/12/2022] Open
Abstract
A case of an extremely healthy, active, 96-year-old patient, nonsmoker, is reviewed. He was initially treated for left V1, V2, and V3 trigeminal neuralgia in 2001, at age 80, with stereotactic radiosurgery (SRS) with a dose of 80 Gy to the left retrogasserian trigeminal nerve. He remained asymptomatic for nine years until his trigeminal pain recurred in 2010. He was first treated medically but was intolerant to increasing doses of carbamazepine and gabapentin. He underwent a second SRS in 2012 with a dose of 65.5 Gy to the same retrogasserian area of the trigeminal nerve, making the total cumulative dose 125.5 Gy. In late 2016, four years after the 2nd SRS, he was found to have invasive keratinizing squamous cell carcinoma in the left posterior mandibular oral mucosa. Keratinizing squamous cell carcinoma is seen primarily in smokers or associated with the human papillomavirus, neither of which was found in this patient. A review of his two SRS plans shows that the left lower posterior mandibular area was clearly within the radiation fields for both SRS treatments. It is postulated that his cancer developed secondary to the long-term radiation effect with a very localized area being exposed twice to a focused, cumulative, high-dose radiation. There are individual reports in the literature of oral mucositis immediately after radiation for trigeminal neuralgia and the delayed development of malignant tumors, including glioblastoma found after SRS for acoustic neuromas, but there are no reports of delayed malignant tumors developing within the general radiation field. Using repeat SRS is an accepted treatment for recurrent trigeminal neuralgia, but physicians and patients should be aware of the potential effects of higher cumulative radiation effects within the treatment field when patients undergo repeat procedures.
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Affiliation(s)
- Aldo Berti
- Miami Neurosurgical Center, University of Miami Hospital
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Singh R, Ansinelli H, Sharma S. Clinical outcomes following stereotactic body radiation therapy (SBRT) for non-resectable pancreatic adenocarcinoma. ACTA ACUST UNITED AC 2017. [DOI: 10.1007/s13566-017-0313-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Familial Trigeminal Neuralgia Treated with Stereotactic Radiosurgery: A Case Report and Literature Review. ACTA ACUST UNITED AC 2017; 6:149-152. [PMID: 29201285 DOI: 10.1007/s13566-017-0300-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background Trigeminal neuralgia (TN) is a chronic pain condition characterized by brief episodes of lancinating pain in one or more distributions of the trigeminal nerve. Episodes of pain secondary to TN are triggered by certain stimuli, such as chewing, shaving, or touching the face. Although a common cause of TN is compression of the trigeminal nerve root entry zone by an artery or vein, many cases of TN are idiopathic. However, there have been limited reports in the literature of familial TN. Case Presentation A 31-year-old male presented with classic TN symptoms in the right V1/V2 distribution that recently progressed to the V3 distribution a case of familial TN. His father an brother both have TN. Carbamazepine, oxcarbazepine, and rhizotomy did not improve his symptoms. He was treated with stereotactic radiosurgery (SRS) with a dose of 85 Gy delivered to the proximal trigeminal root with improvement in his pain. We also review and summarize the over 160 cases of familial TN found in the literature. Conclusions This is the first reported case of familial TN treated with SRS. Patients with familial TN are more likely to have bilateral disease, to present with earlier onset, and to become refractory to medical therapy and may require more aggressive approaches. We propose that SRS is a good treatment approach for these patients.
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